Computed tomography assessment of PEEP-induced alveolar recruitment in patients with severe COVID-19 pneumonia
- Creators
- Ball L.
- Robba C.
- Maiello L.
- Herrmann J.
- Gerard S. E.
- Xin Y.
- Battaglini D.
- Brunetti I.
- Minetti G.
- Seitun S.
- Vena A.
- Giacobbe D. R.
- Bassetti M.
- Rocco P. R. M.
- Cereda M.
- Castellan L.
- Patroniti N.
- Pelosi P.
- Ball L.
- Gratarola A.
- Loconte M.
- Molin A.
- Orefice G.
- Iannuzzi F.
- Costantino F.
- Battioni D.
- Bovio G.
- Buconte G.
- Casaleggio A.
- Cittadini G.
- Dogliotti L.
- Giasotto V.
- Pigati M.
- Santacroce E.
- Zaottini F.
- Dentone C.
- Taramasso L.
- Magnasco L.
- Valbusa A.
- Bastianello M.
- Others:
- Ball, L.
- Robba, C.
- Maiello, L.
- Herrmann, J.
- Gerard, S. E.
- Xin, Y.
- Battaglini, D.
- Brunetti, I.
- Minetti, G.
- Seitun, S.
- Vena, A.
- Giacobbe, D. R.
- Bassetti, M.
- Rocco, P. R. M.
- Cereda, M.
- Castellan, L.
- Patroniti, N.
- Pelosi, P.
- Ball, L.
- Gratarola, A.
- Loconte, M.
- Molin, A.
- Orefice, G.
- Iannuzzi, F.
- Costantino, F.
- Battioni, D.
- Bovio, G.
- Buconte, G.
- Casaleggio, A.
- Cittadini, G.
- Dogliotti, L.
- Giasotto, V.
- Pigati, M.
- Santacroce, E.
- Zaottini, F.
- Dentone, C.
- Taramasso, L.
- Magnasco, L.
- Valbusa, A.
- Bastianello, M.
Description
Background: There is a paucity of data concerning the optimal ventilator management in patients with COVID-19 pneumonia; particularly, the optimal levels of positive-end expiratory pressure (PEEP) are unknown. We aimed to investigate the effects of two levels of PEEP on alveolar recruitment in critically ill patients with severe COVID-19 pneumonia. Methods: A single-center cohort study was conducted in a 39-bed intensive care unit at a university-affiliated hospital in Genoa, Italy. Chest computed tomography (CT) was performed to quantify aeration at 8 and 16 cmH2O PEEP. The primary endpoint was the amount of alveolar recruitment, defined as the change in the non-aerated compartment at the two PEEP levels on CT scan. Results: Forty-two patients were included in this analysis. Alveolar recruitment was median [interquartile range] 2.7 [0.7–4.5] % of lung weight and was not associated with excess lung weight, PaO2/FiO2 ratio, respiratory system compliance, inflammatory and thrombophilia markers. Patients in the upper quartile of recruitment (recruiters), compared to non-recruiters, had comparable clinical characteristics, lung weight and gas volume. Alveolar recruitment was not different in patients with lower versus higher respiratory system compliance. In a subgroup of 20 patients with available gas exchange data, increasing PEEP decreased respiratory system compliance (median difference, MD − 9 ml/cmH2O, 95% CI from − 12 to − 6 ml/cmH2O, p < 0.001) and the ventilatory ratio (MD − 0.1, 95% CI from − 0.3 to − 0.1, p = 0.003), increased PaO2 with FiO2 = 0.5 (MD 24 mmHg, 95% CI from 12 to 51 mmHg, p < 0.001), but did not change PaO2 with FiO2 = 1.0 (MD 7 mmHg, 95% CI from − 12 to 49 mmHg, p = 0.313). Moreover, alveolar recruitment was not correlated with improvement of oxygenation or venous admixture. Conclusions: In patients with severe COVID-19 pneumonia, higher PEEP resulted in limited alveolar recruitment. These findings suggest limiting PEEP strictly to the values necessary to maintain oxygenation, thus avoiding the use of higher PEEP levels.
Additional details
- URL
- http://hdl.handle.net/11567/1046219
- URN
- urn:oai:iris.unige.it:11567/1046219
- Origin repository
- UNIGE